Behavioral Health Medical Director - Ohio

Profile

Description

Humana's Medicaid Behavioral Health Medical Director will oversee our behavioral health (BH) clinical program for Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) and the Behavioral Health Administrative Director to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), quality improvement, and value-based payment programs. The BH Medical Director will be based in Ohio and will also lead the development of new products and services in Humana's Medicaid BH delivery model.

Responsibilities

Job Title: Behavioral Health Medical Director- Ohio

Location: Must live in Ohio

Essential Functions and Responsibilities


Lead major clinical and quality management components of Humana's BH services
Provide clinical case management consultations and clinical guidance for contracted primary care physicians (PCPs) treating BH-related concerns not requiring referral to BH specialists
Develop comprehensive care programs for the management of youth and adult BH concerns typically treated by PCPs (such as ADHD and depression)
Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; accountable for overall continuous improvement of BH services and programs
Oversee, monitor, and assist with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all enrollees under age 18
Work closely with the UM of services and associated appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
Develop targeted education and training for Humana PCPs to screen for mental health and SUD using evidence-based tools (e.g. AUDIT-C, PHQ-9, CANS and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices
Lead BH policy development in the state, driving implementation, oversight, and accountability for both Humana internal and external stakeholders
Adhere to and comply with federal and state laws and programmatic requirements
Collaborate with state agencies, other health plans and OhioRISE health plan for health plan members who qualify for OhioRISE coverage and services
Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network as well as consultation on BH network development
Establish and maintain relationships with providers, advocates, and other key state stakeholders by maintaining open and ongoing communications; represent Humana at public forums and engagement opportunities
Maintain compliance with BH-related contract requirements and attend oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery
Collaborate closely with corporate and local population health teams in developing programs and strategies to address BH needs at a population health level
Participate in regulatory/accreditation reviews
Play a lead role in monitoring the overall safety of members with a behavioral health diagnosis, with a special focus on safe prescribing of psychotropic medications as well as all controlled substances


Required Qualifications


Physician with a current, unencumbered Ohio state license as a physician
Board-certified in psychiatry
At least three (3) years of training in a medical specialty
Experience with children's behavioral health
Experience with ASAM levels of care
Experience developing and Implementing evidence-based clinical policy
Knowledge of the managed care industry
Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, discharge planning and/or home health or rehab


Preferred Qualifications


Five (5) years or more clinical experience working in behavioral health
Familiarity with whole person care and population health concepts
Experience working with multi-system youth
Familiarity with state-based behavioral health organizations
Medicaid Managed Care clinical or behavioral health leadership experience
Familiarity and experience with public speaking and presentations


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Scheduled Weekly Hours

40

Company info

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